*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

Indian H1N1 outbreak claims 16 lives in one month

With onset of monsoon season in Southeast Asia, influenza is considered a common monsoon-related malady. In southwest India, the state of Kerala is suffering from a large resurgence in H1N1 infections. Of the 16 deaths due to H1N1 the agrarian state has reported since May 15th, 9 were pregnant women. India’s National Centre for Disease Control has sent its Joint Director with an epidemiologist and a virologist as a three-doctor swift response team to the state capital, Thiruvananthapuram, to investigate and combat the outbreak. In addition, the Indian parliament has approved shipments to Kerala of 600 000 Oseltamivir tablets, 20 000 bottles of pediatric syrup and 31 000 doses of vaccine. Monsoon season is expected to last another two to three months. Infocera

Vietnam wants to lower its pandemic alert level

Not content to wait for the World Health Organization’s review in July, Vietnam’s Deputy Minister of Health Trinh Quan Huan has suggested lowering his country’s H1N1 alert level. According to Huan, his ministry had “heard” that senior WHO officials had been lobbied by pharmaceutical companies to influence the official pandemic declaration. “This is a big issue,” he said. The Vietnam Health Ministry spent approximately $52.5 million on pandemic prevention measures last year. Thanh Nien News

New Zealand vaccinates record numbers of citizens

The New Zealand government says over a million of its citizens were vaccinated against the flu this year; the highest number of people ever to respond to its public immunization program. New Zealand Health Minister Tony Ryall congratulated health officials, doctors and nurses on their “great job” and urged those who qualify for free vaccinations “to take up this offer while vaccine stocks last”. New Zealand’s last census estimates the country’s population at 4.3 million. TV3 News

*Cases reported by The World Health Organization (WHO) are as of June 6, 2010

International News

The WHO, CIDRAP and others continue to respond to BMJ allegations

Defenders of the World Health Organization’s pandemic recommendations continue to surface in the face of criticism from the British Medical Journal, now the BMJ. Earlier this month the BMJsuggested the UN body had come under the influence of drug industry corruption and that the H1N1 guidelines provided by three of its flu experts were suspect. David Ozonoff, an epidemiologist at the Boston University School of Public Health, called the report a “smear” that insinuates the serious charge that they would have given different advice if they hadn’t had relationships with drug companies. The BMJ authors Deborah Cohen and Philip Carter responded, “We think this is the researcher’s reading into it, not necessarily ours.”

Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, called the article “irresponsible and reckless” saying, “There was nothing in those guidelines that was not based on the best science available. To suggest that the three scientists were able to direct and control the final recommendations [of the 22-member panel] is naive, and stated without a single shred of evidence.”

Epidemiologist Marc Lipsitch at the Harvard School of Public Health compared the situation with the Deepwater Horizon oil spill in the Gulf of Mexico: “It is ironic, as we watch […] the catastrophic results of ‘best-case scenario planning’ […], to have the WHO coming under criticism for planning for, and raising awareness of, the possibility of a severe pandemic. […] They should be commended for it.”

Director General of the WHO Margaret Chan sent an open letter to the BMJ in response to the article. In it, she allowed that transparency and stricter rules of engagement with industry were issues the agency was working to improve on, but “at no time, not for one second, did commercial interests enter my decision-making.”

According to the Journal article, “pharmaceutical companies, […] put pressure on WHO to declare a pandemic. It was the declaring of the pandemic that triggered the [vaccine purchasing] contracts.” However, many countries including the United Kingdom, France, Finland, Canada, the Netherlands, Switzerland, and the United States had already activated their contracts and placed large orders for H1N1 vaccine weeks before the WHO declared the pandemic on June 11, 2009. Therefore, the Emergency Committee could not have influenced these in any way. “You are absolutely right,” conceded the authors of the BMJ article when challenged with this timeline. Nature News

Pandemic, one year later

The H1N1 pandemic is officially a year old as of last Friday. On June 11, 2009, the World Health Organization’s Director General declared the H1N1 outbreak was a phase-six pandemic. The avian (H5N1) flu virus had led the public to associate the term “pandemic” with high death rates, so the WHO hesitated making the declaration over concerns it would cause undue alarm. The announcement came about seven weeks after the virus surfaced. A year later, labs officially confirm H1N1 has claimed 18,156 lives though the actual count, which won’t be known for years, is expected to be many times higher. While H1N1 activity has tapered off in most parts of the world, the WHO maintains a phase six alert. World Health Organization

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

International News

In the face of criticism, some powerful support steps forward for the WHO

There is no shortage of criticism for the World Health Organization’s (WHO) handling of the H1N1 outbreak. Chat forums and web logs are rife with accusations of collusion with the pharmaceutical industry. Almost a third of the European Union’s members of parliament have signed a petition criticizing the WHO’s handling of the influenza pandemic and calling for an investigation.

This week the World Health Assembly, the decision-making arm of the WHO, convenes to discuss a range of global health issues including the H1N1 pandemic response. At the first day of the gathering, France, India, and the US gave public statements in support of the WHO’s efforts. French Health Minister, Roselyne Bachelot went so far as to issue a point-by-point rebuttal of the criticisms saying the UN agency had been “taken to task in an unjust manner,” and that “the vaccine, which was the answer to a real danger, turned into a source of risk in the collective mind. The effects of this smear campaign are potentially devastating.”

In her opening address to the assembly, WHO Director-General Margaret Chan said that the news regarding the pandemic is mostly good, and while public health successes are usually owed to political commitment, adequate resources and cooperation, this time we were “just plain lucky.” For India’s part, this seems to either represent a 180° change in their position, or that their earlier criticism was a political gambit. Agence France-Presse

H1N1 response review committee holds its first press conference

On May 19 the external review committee for the WHO’s pandemic response held a press conference to discuss the findings of their first meeting. The group’s final report will be a public document and is under no restrictions on scope of their recommendations. Dr. Harvey Fineberg, chair of the review committee outlined their mandate saying they were looking to into any aspect that bears on lessons for the future saying, “We want to offer recommendations that are keyed to the problems we find. We want to offer recommendations that enable the world, WHO and the nations, to do better the next time, and we are confident there will be a next time.”

The committee plans to measure the WHO’s response in term of 5 issues: preparedness, alert, response, communication and International Health Regulations performance. To facilitate its investigation, the committee will have access to confidential WHO documents and data. While the report will be public, Dr. Fineberg said that the group will have no authority to compel confidential documents into the public view. When asked what types of confidential information the group had, he described it as mostly letters of agreement and contracts with private industry. World Health Organization

*Cases reported by The World Health Organization (WHO) are as of May 9, 2010

National News

H1N1 claims the life another Canadian

A Quebecois man who recently returned from a trip to Cuba has died after contracting the H1N1 virus. The man passed away in a Montreal hospital after transferring from Shawinigan, near his home. Quebec health authorities say the death does not mark the beginning of a third pandemic wave. “We know now that there are many flu cases in Cuba,” said Dr. Gilles Grenier, a public health director in the Shawinigan region. “The hypothesis is that he got the virus over there, so it’s really an isolated case.” The man, who was in his fifties, suffered from asthma and had not been vaccinated against H1N1. CBC News

International News

India approves its first H1N1 vaccine supplier

The Drug Controller General of India has approved pharmaceutical company Zydus Cadilia to market its own H1N1 vaccine. The nod makes Zydus Cadilia the first company in India to domestically to launch an H1N1 vaccine. The Ahmedabad-based company will use Vaxxicare, its preventative medication division, to sell the vaccine under the trade-name VaxiFlu-S. “With the development and launch of vaxiflu-s, Zydus now has proven capabilities in researching, developing, and manufacturing of safe and efficacious vaccines,” said Pankaj Patel, the company’s chairman and managing director. He went on to say that he expects Zydus Calilia to soon produce vaccines for other viral, bacterial and protozoal infections. Hindustan Times

Researchers say the benefits of H1N1 prophylaxis must be quantified against side-effects

A study published in the European science journal Eurosurveillance reports that side-effects are a significant factor in the dispensing of the anti-viral drug oseltamivir as a mass, preventative antiviral blanket. Of the students and staff at a British elementary school given the drug in June 2009 as a prophylactic measure, 42% reported adverse side-effects and 15% did not complete the course of oseltamivir due to adverse effects. The authors of the study call for an assessment of each patient’s likelihood of infection to avoid unnecessary treatment. Eurosurveillance

*Cases reported by The World Health Organization (WHO) are as of May 2, 2010

International News

H1N1 may have been a milder pandemic than expected, but in populations affected by the disease, the impact has been profound.

In a meeting with the American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention issued a statement saying that the two pandemic waves of H1N1 in America have claimed the lives of 317 patients under the age of 18. Compared to the last five years, that amounts to over 3.5 times the pediatric mortality rate for seasonal influenza. The average age for deaths was 9.4 years, older than the previous averages which were a little over 6 years. Of the deaths, 65% (205) of the patients were in a high risk category for influenza-related complications due to underlying conditions such as obstructive pulmonary disease, neurological disorders, asthma, and heart disease. In contrast, only 43% of those who died in the previous two seasons had these conditions. CDC Flu Activity and Surveillance

Routine pediatric vaccination uptake on the decline in the US

A study released by the U.S. Centers for Disease Control and Prevention shows that more American parents are refusing or significantly delaying vaccinations for their children. Compared with parents who opted for vaccinations, those who declined were less likely to believe that their children were susceptible to vaccine-preventable diseases, that the diseases were a health concern, or that vaccines are safe and effective. Children who are not immunized by 19 months of age risk being more vulnerable to vaccine-preventable diseases. CBC News

Vaccine shortages in Australia

Australia’s supply of seasonal influenza vaccine, which includes protection from pandemic H1N1, is running low. In Victoria, Australia’s second most populous state, pharmacies have started waiting lists for people seeking immunizations. Because of the unexpected demand, CSL, the company that makes most of the country’s vaccines, rushed a second batch to market but warns that there may be more shortages. The Herald Sun

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

National News

Overall influenza activity has continued to be low for at least 17 consecutive weeks. Only one specimen (out of 1,379) tested positive for pandemic H1N1 2009 in the third week of April. No new H1N1-related hospitalizations and deaths have been reported this week. To date, only 14 hospitalizations and two deaths have occurred across Canada since the beginning of 2010. As of week 14, influenza activity level in the Southern Hemisphere continues to be low in general. Of note, however, in Chile, there was evidence of early localized pandemic influenza virus transmission in advance of the usual start of the southern hemisphere winter influenza season. PHAC FluWatch

International News

Australian Broadcasting Corporation (ABC) has reported that the number of children in West Australia who had convulsions or fever and vomiting after receiving a seasonal flu vaccine that covers the pandemic strain has grown to 251. Officials say the immunizations likely came from multiple batches. Queensland is also investigating the possibility of adverse reactions in children, and police in Brisbane are probing the death of a recently vaccinated 2-year-old, according to other ABC reports. ABC

*Cases reported by The World Health Organization (WHO) are as of April 4, 2010

International News

After a quiet start to the year, Bangladesh is reporting rapid spread of pandemic flu this month and has placed health officials across the country on alert. “The virus sustained at a lower level in Bangladesh during January-March period, but it showed rising trend since the beginning of this month,” a health official said, adding that April through September is typically the busiest season for flu. He did not specify case numbers. Balita

Nigeria has yet to receive any H1N1 pandemic vaccine and is concerned that cases may grow as nearby Ghana is reporting an outbreak. Nigeria has confirmed 11 cases and 2 pandemic deaths. The story quoted unnamed experts as saying global demand for the vaccine has outpaced supply, making it difficult for developing countries to obtain doses. Nigeria Bulletin

In the biggest and most detailed look yet at pandemic flu infections in pregnant women, researchers from the US Centers for Disease Control and Prevention (CDC) have reported that early antiviral treatment was linked to fewer intensive care unit (ICU) admissions and that severe illnesses and deaths are more likely to occur during the third trimester. The CDC researchers, along with a Pandemic H1N1 Influenza in Pregnancy Working Group made up of health officials from several U.S. states, based their findings on reports of pregnant women who were sick with pandemic H1N1 infections through August plus more recent reports of women who were admitted to ICUs. The findings appear in the Apr 21 issue of the Journal of the American Medical Association (JAMA). CIDRAP